Bird Flu

[Kimka83]

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Hey guys,
I'm sure no one really wants to talk about this topic, and much is speculation at this point. But . . . I just ended up in a big argument with my mom over this issue. She says that next year is likely to be the big epidemic, and thus she doesn't want me going to a medical school where first year students have any clinical exposure. She said that first year students are expendible, and if the clinics turn into a "war zone" with thousands dying, medical schools will just send us out there to die. She said that they have already spent money training older students, but they won't hesitate to "just leave us out there." (whatever that means) She started equating hospitals to war zones, saying some people are expendible, like med students and nurses. WHAT?!?!? So basically, I shouldn't go into the clinic or shadow a doc because I am going to get coughed on, and catch bird flu, and die. An the medical school will not care.
This made me furious! 😡 She wants me to go to a school with no clinical exposure for first year students. Is there even such a place? Maybe, and I am sure they are fine schools . . . but I have worked so hard for this. I want to choose the best school I can go to, not the school with the least clinical exposure. Grrrr. She made me so mad. I think that she is really over-reacting. Anyway, first year students really can't treat patients. If there is some sort of crazy pandemic, what could it do for medical schools to send in a bunch or clueless first years? I don't think schools have any reason to use us as cannon fodder.
Does anyone else think that she is wrong about this?
I really hadn't even thought about it, and I don't think I will consider the flu issue when choosing a school. I mean, if this pandemic never occurs and I go to a not so great school, I'm stuck with that for the rest of my life. But she just started crying and talking about how I am so proud about medical school that I am willing to sacrifice my life. Well maybe I am.
Any thoughts?

 

[Turkeyman]

Wow. I don't have many thoughts on that except for you to do exactly what you were planning to do. Good luck.

 

[LadyWolverine]

lol...tell your mom to chill. You're applying to medical school, so I'm assuming that you are an adult now and can make your own decisions. Her doomsday scenario is more than a little far-fetched. I doubt that there's a hospital anywhere in this country that would let a bunch of first-years loose in a hospital, pandemic or no.

I think that people are blowing this H5N1 thing WAAAAY out of proportion. Even ProMED/ISID has something about it every day. Preparation is essential, but not full-blown panic. I see now what watching too many misinformed/underinformed media reports can do to people like your mom. Sheesh.

 

[IAMS]

Umm.. no hosptial is going to have 1st year med students handling patients.. that just won't happen. 2nd, who do you think gets first priority with any vaccine/anti flu agent? The medical community - those with the most patient contact.. further more, the people who die in most outbreaks are the young / old / and immunity-deficient (Cancer / AIDS patients)... you really shouldn't worry, focus on being healthy and you'll be fine - your mom needs a zoloft.

 

[cardsurgguy]

What qualifications does your mom have for making such a claim about what's going to happen? Is she a virologist or a physician?

If she doesn't have any expertise on the issue, tell her to piss off and just make your own decision, you're a big person now...

Actually, I take that back

Even if she does have some sort of expertise on the issue, still tell her to piss off and make your own decision... 😀

 

[SuzieQ3417]

further more, the people who die in most outbreaks are the young / old / and immunity-deficient (Cancer / AIDS patients)... you really shouldn't worry, focus on being healthy and you'll be fine - your mom needs a zoloft.

I am taking a public health class right now, and we actually discussed the bird flu and the previous major flu epidemic, and what makes these special is that they don't just kill off the weak/old such as is normally the case. Many young, healthy people also died. However, given that only 60 people worldwide have died so far from the bird flu, and all of those people had direct contact with infected poultry (meaning it is not able to pass from human to human unlike previous epidemics) I would say you have very little to worry about. Besides, didn't our govt just spend billions of dollars to stockpile Tamiflu? (for the oh-so-slight chance a major outbreak might occur) Personally, I think this whole thing is being blown out of proportion. To put things in perspective, check out this nytimes article: http://www.nytimes.com/2005/10/25/...tml?ex=1131080400&en=48354254e24fa627&ei=5070 ("Scare yourself silly, but the real terrors are at your feet")

 

[Kimka83]

What qualifications does your mom have for making such a claim about what's going to happen? Is she a virologist or a physician?

If she doesn't have any expertise on the issue, tell her to piss off and just make your own decision, you're a big person now...

Actually, I take that back

Even if she does have some sort of expertise on the issue, still tell her to piss off and make your own decision... 😀

She is a nurse and a lawyer

 

[Nikki2002]

ummmmm.....uhhhhhhhhhh

 

[LadyWolverine]

The current concern is that the virus will acquire the ability to be passed from person-to-person, which will most likely occur in a "mixing vessel" (e.g. pig) that has been exposed to both human and avian flu viruses. The genomes of the different strains mix and mingle, and, bam, instant pandemic. And, yes, because our frail human bodies have never been exposed to these new strains, even us strapping young individuals are at risk. However, in this country, I don't think a pandemic will be as deadly as we are estimating. Tamiflu resistance is a potential problem that is being studied. There are other antivirals that certain H5N1s have shown resistance to. I don't know enough about it. But I think that, given an outbreak, the effects in this country will be far less devastating than in, say, sub-saharan africa.

 

[Turkeyman]

ummmmm.....uhhhhhhhhhh

best response eva

 

[lazygunner]

The current concern is that the virus will acquire the ability to be passed from person-to-person, which will most likely occur in a "mixing vessel" (e.g. pig) that has been exposed to both human and avian flu viruses. The genomes of the different strains mix and mingle, and, bam, instant pandemic. And, yes, because our frail human bodies have never been exposed to these new strains, even us strapping young individuals are at risk. However, in this country, I don't think a pandemic will be as deadly as we are estimating. Tamiflu resistance is a potential problem that is being studied. There are other antivirals that certain H5N1s have shown resistance to. I don't know enough about it. But I think that, given an outbreak, the effects in this country will be far less devastating than in, say, sub-saharan africa.

One of my interviews was with an infectious disease specialist and what he told me was kind of scary. Basically, if this thing mutates where it can be passed from person-to-person soon, we may be screwed. Although only a small number of people have died from it so far, this number is half of those infected. Compared to the ~2% death rate of the early 1900 flu epidemic, this is quite alarming. Furthermore, while many people figure it's not a problem because they're never around poultry farms, think again...the primary agent of transmission is not livestock, but migrating birds. I'm hoping someone comes up with a solution for this reeeeal fast...

 

[LadyWolverine]

One of my interviews was with an infectious disease specialist and what he told me was kind of scary. Basically, if this thing mutates where it can be passed from person-to-person soon, we may be screwed. Although only a small number of people have died from it so far, this number is half of those infected. Compared to the ~2% death rate of the early 1900 flu epidemic, this is quite alarming. Furthermore, while many people figure it's not a problem because they're never around poultry farms, think again...the primary agent of transmission is not livestock, but migrating birds. I'm hoping someone comes up with a solution for this reeeeal fast...

See, it is statistics like these that make people crazy. And, no offense, but they are misinformed. It may seem like half of those infected are dying. But it is quite likely that other people are getting infected and either not showing symptoms, or are not going to hospitals for treatment. Think about where these infections are occuring - mostly rural areas of SE asian countries. I doubt they have the access to facilities that other countries (like us) have. The mortality rate of this flu is not likely to be 50%.
You are correct about migratory birds (particularly waterfowl) carrying H5N1. The livestock issue, however, is what makes it dangerous to humans. As I stated before, there is the necessity of a mixing vessel to create a human-to-human transmissible strain. You are not going to contract avian influenza by sitting at the neighborhood park looking at infected geese. The actual first H5N1 infections that were learned of in these SE asian countries occured because fighting cock owners were clearing the nasal secretions of their prized birds by sucking them out with their own mouths (in other words, YUCK). Others occured because children were crawling around in the pens with the chickens and having close contact with feces, etc. So there is some significant contact needed in order to contract H5N1. I think that avian influenza IN ITS CURRENT FORM is much more of a threat to the economy/livestock industry than it is to people in this country as a public health threat.

Of course, if that fateful hybrid occurs, then it is possible for human-human transmission, and all bets are off. But I still don't think it would be as devastating as has been speculated.

 

[IDforMe]

See, it is statistics like these that make people crazy. And, no offense, but they are misinformed. It may seem like half of those infected are dying. But it is quite likely that other people are getting infected and either not showing symptoms, or are not going to hospitals for treatment. Think about where these infections are occuring - mostly rural areas of SE asian countries. I doubt they have the access to facilities that other countries (like us) have. The mortality rate of this flu is not likely to be 50%.
You are correct about migratory birds (particularly waterfowl) carrying H5N1. The livestock issue, however, is what makes it dangerous to humans. As I stated before, there is the necessity of a mixing vessel to create a human-to-human transmissible strain. You are not going to contract avian influenza by sitting at the neighborhood park looking at infected geese. The actual first H5N1 infections that were learned of in these SE asian countries occured because fighting cock owners were clearing the nasal secretions of their prized birds by sucking them out with their own mouths (in other words, YUCK). Others occured because children were crawling around in the pens with the chickens and having close contact with feces, etc. So there is some significant contact needed in order to contract H5N1. I think that avian influenza IN ITS CURRENT FORM is much more of a threat to the economy/livestock industry than it is to people in this country as a public health threat.

Of course, if that fateful hybrid occurs, then it is possible for human-human transmission, and all bets are off. But I still don't think it would be as devastating as has been speculated.

Lady Wolverine is right, however, let me just say what is going on with avian influenza right now is part media overattention and part overdue recognition of something that most people in public health and infectious disease have been aware of for a long time. Basically, it goes like this: influenza virus naturally has genetic drift which occurs from flu season to flu season (and is the reason the vaccine is just made up according to the expert's best predictions of what strains will be circulating in a given year), but also occasionally has large changes in it's genome called genetic shifts. The pandemics in the past, are thought to be the result of just such a large change in the virus. New research and the reconstruction of the strain causing the 1918 "Spanish" influenza pandemic, indicates that the virus responsible was closer to a true avian influenza type virus than previously thought. This does mean that we should be paying attention to H5N1, and trying to limit it's spread and the opportunity for it to mix with other strains or mutate to become more transmissible or lethal to humans. BUT... this does not mean that the next influenza pandemic will be caused by it, and even if it is, it could happen tomarrow or ten years from now. From what we know of past trends regarding influenza pandemics, we are currently overdue for one. The big lesson to take from the whole media storm occuring now, however, is that 1.) surveillance and immediate response to limit and control highly pathogenic emerging strains of influenza is important, and 2.) we must plan for the worst even as we try to make certain that it does not happen.
Honestly, right now neither our country or the rest of the world is ready to withstand an influenza pandemic. If this occurs, there will be casualties. Just keep in mind, humanity has been facing such things for a very, very long time. As long as we can increase awareness of the potential problem, we can work on a solution. And at this point, that recognation in conjunction with the attempts to plan for such a situation makes us better prepared for an influenza pandemic than at any previous point in human history.

And because I've kind of rambled away from the topic now, let me return to say, once again that I agree with Lady Wolverine when she mentions the possible economic impact of a pandemic. We might be able to better control the virus and treat people, and so reduce the number of deaths in this country, but combine the living conditions (in relation to birds) in Africa and Asia, along with diseases that result in decreased immunity, like HIV/AIDS, TB, etc, etc, etc, and poor hygiene/living conditions, and a pandemic would surely have a much more devastating impact in terms of human lives in these locations. If we don't try to protect everyone, in every country, the collapse of the global economy because of a pandemic's impact in these areas would, in my opinion, be just as destructive (if not more so) than the influenza virus itself.

 

[Jugador75]

Ok, let’s clarify some issues. As a 2nd year med student at NYU, the place where the vast majority of patients would be treated if any major disaster happens in NYC, I can speak with some authority on this.

First off – whether bird flu happens next year or 5 years from now, it is a VERY scary idea that should not be taken lightly. Ladywolverine is somewhat correct – the mortality rate would not likely be as high as 50%, as quoted in the media. In fact, it has already started coming down to the 30-40% range. In fact, as a trend these viruses tend to become less virulent as they evolve (natural selection – it’s in their own best interest NOT to kill the host – that way they are more likely to be transmitted to someone else). Having said that, a whole lot of people could die in the 6-month minimum time period between when the virus first becomes transmissible from human-human and when the first effective vaccines can be produced. That’s right folks – 6 months. The vaccines that Bush is currently stockpiling are not likely to be effective, since we don’t know what we’re up against yet.

We have had lectures on bird flu from Peter Palese (one of the top 3 researchers in the world on influenza) and Marci Layton (NYC department of health’s director of communicable diseases). The consensus seems to be that “it’s not a matter of if, but when.”

I think someone already corrected ingamina’s mistake above about this virus predominately affecting the young, old, and immunocompromised. This is not true.

As for the original poster’s question – Kimka83 – tell your mother this. No 1st year med student in this entire country would be sent out into a hot zone without proper training and protective equipment. As the president and founder of a student-based disaster preparedness club here at NYU, I have been working very hard to implement exactly what your mother is afraid of – having 1st and 2nd year med students be available to help out in the event of a major disaster, with the caveat that they have received all of the proper safety training ahead of time. And I can tell you (and you can tell your Mom) that the school has been extremely reluctant to use students in this capacity, even WITH adequate training. They simply do not want to put students in harms way. And anyway, it would be almost impossible for you to figure out which schools would be more/less likely to use 1st year med students in such a capacity. The only thing you could do, if you were really paranoid, is go to some school in the Midwest, where at least the chances for terrorism are significantly less (although the bird flu can still getcha!)

Hope this helps.

 

[IDforMe]

Thanks for providing the info Jugador. I'm pretty up to date with avian influenza because of my job, but I hesitate to start spouting off about it. I'm glad you posted with a lot of the facts that I know but don't want to be here all night typing.
I'll be happy to keep posting on this subject, but ask some specific questions, please. Otherwise, I'm not sure where to start on the subject-- I don't want to waste time posting something that everybody already knows. There is a lot of information out there and a lot of misconceptions and misinformation out there as well.

 

[dajimmers]

The avian flu is certainly something to worry about, but no more so than any of the other many viruses and bacteria plaguing the earth. The media overhypes all of these things, but if you look at the statistics, there is usually less chance of death than you risk every day (driving, smoking, eating a cake, living in certain areas, etc.) Ex= Mad Cow.

Yes, flu has been a beast in the past, and can be again. Luckily we know what has to happen before it can do that (become human-human transmissible, or convince infected waterfowl to attack us with their nasal secretions 🙂 ).

Should you be worried? Yes. And you should probably read up on the real stuff (not the media version)- why was flu so bad in the past, how is it transmitted, how does it mutate, etc. But it's not time to go hide on a desert island or in a nuclear fallout shelter for 10 years.

 

[crazy_cavalier]

Tell her the bird flu apocalypse is about as ridiculous as the "Y2K" craze that everyone had 5 years ago. Thank the U.S. Media for over-inflating such topics as mad cow disease and bird flu.

I'll tell you now, when you die, there's a really high chance (50%+) that the cause of your death will be either cancer or heart disease. Bird flu? Highly improbable.

 

[BMW M3]

further more, the people who die in most outbreaks are the young / old / and immunity-deficient (Cancer / AIDS patients)... you really shouldn't worry, focus on being healthy and you'll be fine - your mom needs a zoloft.

Um... I really have to disagree with you on this one. If you look at the stats of the people dying in Southern Asia, its predominantly HEALTHY YOUNG MEN AND WOMEN in their Teens, 20's and 30's. H5N1 kills w/o regard to age. W/o vaccination, we are ALL vulnerable.

 

[IDforMe]

dajimmers: "But it's not time to go hide on a desert island or in a nuclear fallout shelter for 10 years."

Yeah. And don't bother trying to stockpile Tamiflu either.
1.) It may now work against whatever version of the virus does become pandemic
2.) You couldn't get a large enough supply to take it prophylactically (How much of a supply could you get? 6 months, a year?)
3.) People can transmit influenza before they have any symptoms (And you'll eventually have to leave the house for work, or at least to get groceries)

So... become informed, and learn about the risks. Take the threat of a pandemic seriously. At this point, practice good hand hygiene and keep up to date on what's going on from reputable sources (not most media), but don't live in fear. Not only is that paranoid, it's futile.

 

[IDforMe]

Tell her the bird flu apocalypse is about as ridiculous as the "Y2K" craze that everyone had 5 years ago. Thank the U.S. Media for over-inflating such topics as mad cow disease and bird flu.

I'll tell you now, when you die, there's a really high chance (50%+) that the cause of your death will be either cancer or heart disease. Bird flu? Highly improbable.

Have to agree about the mad cow disease. Have to disagree about influenza (bird flu or other strain, whatever happens to win the genetic lottery for jumping into nice juicy human hosts)

I'm not saying you're more likely to die of flu at this point in time, but in a pandemic that might change.

 

[SanDiegoSOD]

Is your mom going to be paying for med school? If she is, you need to be sensitive to her concerns. If she isn't, then it really doesnt matter what she thinks, does it? 😉

 

[Law2Doc]

Hey guys,
I'm sure no one really wants to talk about this topic, and much is speculation at this point. But . . . I just ended up in a big argument with my mom over this issue. She says that next year is likely to be the big epidemic, and thus she doesn't want me going to a medical school where first year students have any clinical exposure. She said that first year students are expendible, and if the clinics turn into a "war zone" with thousands dying, medical schools will just send us out there to die. She said that they have already spent money training older students, but they won't hesitate to "just leave us out there." (whatever that means) She started equating hospitals to war zones, saying some people are expendible, like med students and nurses. WHAT?!?!? So basically, I shouldn't go into the clinic or shadow a doc because I am going to get coughed on, and catch bird flu, and die. An the medical school will not care.
This made me furious! 😡 She wants me to go to a school with no clinical exposure for first year students. Is there even such a place? Maybe, and I am sure they are fine schools . . . but I have worked so hard for this. I want to choose the best school I can go to, not the school with the least clinical exposure. Grrrr. She made me so mad. I think that she is really over-reacting. Anyway, first year students really can't treat patients. If there is some sort of crazy pandemic, what could it do for medical schools to send in a bunch or clueless first years? I don't think schools have any reason to use us as cannon fodder.
Does anyone else think that she is wrong about this?
I really hadn't even thought about it, and I don't think I will consider the flu issue when choosing a school. I mean, if this pandemic never occurs and I go to a not so great school, I'm stuck with that for the rest of my life. But she just started crying and talking about how I am so proud about medical school that I am willing to sacrifice my life. Well maybe I am.
Any thoughts?

While I think the bird flu threat is a real one, the bottom line is that those in or going into the medical profession are at the front line for every illness, and frankly the bird flu is not the one you are most likely to come into contact with first, or even the most contageous. In the clinical hospital setting you will will have the opportunity to get exposed to a ton of stuff, most of which is benign. But I would be more worried about getting sick from an antibiotic resistant strain of a common illness, than from one of the more exotic ones.
(I doubt this thought will be comforting to your mom, though).

 

[IAMS]

Um... I really have to disagree with you on this one. If you look at the stats of the people dying in Southern Asia, its predominantly HEALTHY YOUNG MEN AND WOMEN in their Teens, 20's and 30's. H5N1 kills w/o regard to age. W/o vaccination, we are ALL vulnerable.

Forgive me for speaking generally where this is about birdflu. Though, it hasn't spread from person-person. if and when it does, it will probably not be the same H5N1 virus. So we really don't know what the epidemic/pandemic will look like, how virulent it will be.. and it will take some deaths before a true vaccine could be made.

 

[dsprague12]

If people want to read a good book about the 1918 flu epidemic that will put the prospects of an H5N1 epidemic in perspective, check out The Great Influenza by Cook. It also gives a thorough description of the evolution of the medical school system - specifically Johns Hopkins - from the late 19th century to now.

While times have certainly changed since 1918, the possibility that 1st year students would be called on to help treat patients is not far fetched. Nurses and doctors were in such short supply in 1918 that they did make use of medical students, nursing students ... anyone with any health training, as care providers for the sick.

 

[gujuDoc]

best response eva

Exactly why we all love Nikki........oh and also because of her kitten in a pop tart box. 😀 😀

 

[sunnyjohn]

Quite frankly,

They'll probably send the first years home.

You know less than nothing and would just get in the way of the nursing staff, doctors and everyone else.

Is your mom going to be paying for med school? If she is, you need to be sensitive to her concerns. If she isn't, then it really doesnt matter what she thinks, does it? 😉

I'm with the Hot Dog!

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